Abstract

A 55-year-old man, who previously underwent surgical ventricular restoration and mitral valve surgery, was referred to our department for management of refractory heart and multiple organ failure. At the time of admission to our hospital, he could not be registered as a candidate for heart transplantation because of severe renal failure with a serum creatinine level of 4.6 mg/dl. We considered that he was a marginal candidate for heart transplantation; thus, it was essential to understand the etiology of renal failure and estimate whether it was reversible. Cardiac catheterization revealed poor hemodynamic function with a systemic pressure of 107/60 mmHg, cardiac index of 2.5 l/min/m2, and pulmonary artery pressure of 63/27 mmHg, despite intense medical treatment. Contrary to biochemical examination findings of blood, renal biopsy findings showed no significant glomerular abnormality. Furthermore, the severity of tubular atrophy and interstitial fibrosis in the cortex was mild. These pathological findings suggested that the renal dysfunction in this case was possibly attributable to a hemodynamic factor. His symptoms gradually deteriorated despite an increasing dose of inotropic support; thus, we planned implantation of a Jarvik 2000 axial-flow pump (Jarvik Heart Inc., New York, NY, USA) as a bridge to eligibility, and informed consent was obtained. Because of a tight adhesion on the anterior wall, we placed the device on the lateral wall of the left ventricle, making sure not to direct the pump at the septum. Postoperatively, the implantable left ventricular assist device provided relief from heart failure symptoms as well as recovery of renal function, with serum the creatinine level at 1.2 mg/dl, which allowed the patient to become an appropriate candidate for heart transplantation. At an 18-month follow-up examination, his status was uneventful, and he is now at home awaiting heart transplantation.